Evaluation of an Antiretroviral Adherence Intervention among HIV Infected Patients by Pharmacist

Abstract

To achieve high adherence in HIV treatment, effective antiretroviral therapy is required. Pakistan has very less adherence rate and there is a need to introduce new strategies to improve the adherence. We incorporated pharmacist to assess the impact of educational and counselling intervention on antiretroviral therapy adherence. We conducted this randomised controlled trial from September 2018 to February 2019 at HIV care center in Pakistan Institute of Medical Sciences, Islamabad, Pakistan (PIMS). It compared the intervention group, who was receiving education and counselling about HIV and ART by pharmacist with the group receiving usual care. Participant’s aged 18-75 and those who were already on ART therapy and taking it from last three months and were willing to give consent were included in the study. The primary outcome was self-reported adherence with 2 months follow-up which was measured with the AIDS Clinical Trial Group (ACTG) questionnaire. The secondary outcomes included CD4 cells count and adherence self-efficacy and medication beliefs. This trial was registered with Australian New Zealand Clinical Trials Registry (ACTRN12618001882213). The study enrolled 100 patients among which, 66 patients completed the study, 33 patients each in the intervention group and control group. The patients who were educated and counselled by pharmacist never skipped their medication. The medication intake was increased from 20% to 80% post intervention and the reasons for non-adherence decreased by 10% compared to control group. Pharmacist education also increased the CD4 cells count and patients adherence self-efficacy. They were more confident to take the medicines as prescribed post intervention. The results suggest, although the pharmacist intervention improved the adherence to ART therapy and increase in CD4 cell count, so the pharmacist services can be implemented in other HIV care centers. However, more work is needed to identify the effective interventions and methods to improve ART adherence in resource limited settings.